Patients and Physicians Working Together

Direct primary care is a model of primary care in which doctors and patients contract directly with each other rather than a third party insurance company. Patients pay a periodic membership fee to be a member of the practice, and this fee includes all of the services from the physician as well as direct access to the physician between visits. This direct access allows doctors and patients to have a stronger therapeutic relationship, helps the patient access care quickly when needed, and eliminates insurance barriers that prevent the doctor from providing care that is needed. By eliminating insurance and increasing access to primary care, healthcare costs are significantly decreased and patients can save hundreds to thousands of dollars on their healthcare costs each year.

A direct care physician is any physician who contracts directly with a patient without interference from a third party or insurance company. This is most common in direct primary care practices, but it is becoming more common for specialists to create these agreements as well. This allows both primary care physicians and specialist physicians to provide care to patients without insurance interference that can drive up costs and prevent access to care.

Direct primary care is not a health plan or an insurance plan. It is a model of payment for services received from a particular physician and/or practice. Services provided outside of the practice are not included in the agreement. It is recommended that patients seek alternative coverage for healthcare costs related to emergency care and hospitalizations. Direct primary care practices can help connect patients to resources to find this coverage.

While direct primary care and concierge medicine often offer patients a similar level of access to their doctors, direct primary care memberships are usually much more affordable than concierge medicine practices. Concierge medicine practices will often bill insurance in addition to charging their membership fee, and their membership fee may include more extensive testing than is typically offered in a primary care office.

Patient can use their insurance for any costs for services outside of the direct primary care practice, including labs, imaging, hospitalizations, and surgeries. However, many patients find that paying cash is often cheaper than using their insurance for common labs and procedures. It is recommended that patients check with their insurance plan regarding any restrictions on coverage for testing ordered by out of network physicians such as direct primary care physicians.

Direct primary care membership does not include costs of labs and prescriptions, but practices often provide significant lab discounts through lab partners and are able to direct patients to more affordable resources for prescriptions. Most states allow direct primary care physicians to dispense medications to their patients at wholesale cost, unfortunately this is not currently permitted in the state of Texas.

Direct primary care physicians often need to refer to specialists less frequently than primary care physicians in traditional medical practices as they are able to spend more time with patients to understand their condition and provide recommendations and follow-up. However, when specialist care is needed, patients can be referred to a specialist as usual. There are an increasing number of specialists providing affordable direct care services. Patients can take advantage of these direct care options or use their insurance for coverage of specialist care.

Direct primary care is an excellent health benefit for self-employed individuals and small business owners to provide to their employees. Membership can be covered in full or in part by the employer, and wraparound coverage for emergencies and hospitalizations can also be included at a fraction of the cost of traditional insurance plans.